The Joys and Challenges of Rural Pediatrics

Primary Care Matters is a guest column written for MedStat by a local pediatrician or primary care provider. 

(From the November 2018 Issue of MedStat

Written by Jill Neff, DO, owner/pediatrician of Hometown Pediatrics in Jackson, Ohio and medical director at the Jackson County Health Department

Dr. Neff completed medical school at the Ohio University College of Osteopathic Medicine, and a pediatrics residency at the Doctors Hospital of Stark County. She has been on the medical staff since 2011.

Jill Neff, DOI often tell my medical students to not just pick out a specialty, but first, pick out a place where they want to live. Being happy with one’s life is more important than just being happy with one’s job. If a person prefers to live in a rural setting, then they probably should not become a neuro- or cardiovascular surgeon that requires a fairly dense population to support their specialty. Happiness needs to surround a person in all aspects.

I knew I needed rural life and pediatrics fit that just fine. At times, it has been frustrating. There have been few, if any, peers with whom to converse. There have been precious few medical support systems such as labs and X-rays readily available. The call schedule … well that doesn’t exist as I am the only one on call. Time off has been few and far between, and hardly any other physician/hospital has ever felt the need to help. I have been told not once, but multiple times, “you picked it, you live (deal) with it.” And the pay … well, it’s rural. Jobs are not readily available; family incomes are low. Need I say more? Those are just a few of the frustrations that come to mind.

But, on the other hand, the opportunities and joys are many. I know my families as if they were my own. I call all my patients ‘my kids’ and feel a bit responsible for their trials and tribulations. I have been to pageants, spelling bees, birthday parties and weddings. I have attended to kids hurt on the football field, basketball floor and at parades. I was invited as one patient’s ‘grandparent’ on grandparent day at school (when I was a mere 31) and went “back to school” for an afternoon of teaching. I taught at a free summer arts and crafts camp, and led Brownies on a nature hike. I know that my “kid’s” grandmother drives the school bus and another one raises goats and makes soap. I know which uncle fixes cars and which dad to call to fix my lawn mower. My egg lady drops off eggs at the office and my fix-it-man has three bee hives at my house. If I don’t know most people in town by name, I know them by face, and I greet them at the post office, the grocery, and the gas station.

Challenges? Yes. But, I have used my skills and knowledge and worked it out. Living so far from specialists and support systems, there has been no other option. I have treated pneumonia by history and exam. No X-ray. I have given shots of Rocephin without a spinal tap, feeling confident that the patient has meningitis, and not wanting to wait the hours it takes to get them to a hospital. I have had LifeFlight land in the field beside my office to take a critically ill child away. I have personally ridden with families/transported several children myself to the local ER instead of waiting for a squad. I have hung IV drips from the ceiling tile, babysat a sibling as the parent leaves with the sick child on the way to the hospital, sent my office assistant as a ride-along and hand holder for the two hour drive to the closest children’s hospital, and handed out gas cards and $20 bills so that the person going to the hospital can get there. I have brought my pets in to comfort the children, made many house calls, and transported Amish families in my private vehicle in the middle of the night. It has been rewarding and it has been fun, despite the frustrations and occasional misconceptions from those in more populated regions.

What are my rewards? The smiles of the children, the hugs in the stores, the invitations to events, and the time that I can spend quietly on my 50 acres, far from the noise of the city, all without a commute. I have learned, and am continuing to learn, how to treat most things myself. I do not have the luxury of specialists “just down the street.” We amble through.

Upon first moving here to rural Ohio, I listed my home phone number. At the time, my husband told me I was crazy. People would be calling all hours of the day and night, and I would never get any peace and quiet. But, here’s what happened: hardly anyone has EVER called me, maybe two or three a month, sometimes none. And when they do, the first minute on the phone finds them uttering profuse apologies for bothering me. I am convinced that the folk in rural America have gotten by for so many generations relying on family and their own sense of awareness, that they either make it until morning and then call the office or realize that it is a true emergency and they find their way there. It’s a gift. And a blessing.

I welcome anyone at any time the chance to see how we “play” in the country. My office is an open door to those that want to see a different lifestyle, a different set of challenges, a different set of ideals. And to those who also want to understand and appreciate that Ohio, as well as the world, is not the same in all of the many and varied “neighborhoods,” then come on down. You can email me at jbug536@hotmail.com.

The opinions and policies expressed in MedStat are those of its contributors, and are not necessarily the opinions or policies of Nationwide Children’s Hospital. Nationwide Children's Hospital does not endorse or recommend any specific opinions, policies, tests, physicians, products, procedures, or other information that may be mentioned in MedStat. The content made available on MedStat, such as text, graphics, images, and other material contained on the website are for general educational and informational purposes only and do not constitute medical advice; the content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Reliance on any content provided by MedStat is solely at your own risk.